HIV-coinfected patients respond worse to direct-acting antiviral-based therapy against chronic hepatitis C in real life than HCV-monoinfected individuals: a prospective cohort study

Neukam, Karin; Amado, Luis Enrique Morano; Rivero‐Juárez, Antonio; Mancebo, M.J.; Granados, Rafael; Téllez, Francisco; Collado, Antonio; Rios, María; Santos-Gil, Ignacio de los; Reus, Sergio; Vera-Méndez, Francisco Jesús; Geijo-Martínez, Paloma; Montero, Marta; Suárez-Santamaría, Marta; Pineda, Juan A.

doi:10.1080/15284336.2017.1330801

Cited by 33 publications

(28 citation statements)

References 25 publications

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“…These results contrast with the recently published findings of Neukam et al, which suggested that HIV-coinfected patients respond less well to DAA-based therapy. The authors discuss a higher frequency of liver cirrhosis in the HIV-coinfected patients as a possible explanation for their findings [15]. Liver cirrhosis has indeed been described as a risk factor for lower response rates in some studies, especially in GT 3 patients [16,17].…”

Section: Discussionmentioning

confidence: 87%

“…Showing higher relapse rates and lower cure rates in HIV/HCV‐coinfected individuals, they also conclude that shortening of treatment duration in these patients should be discussed critically. Their data support the findings from the ALLY‐2 clinical trial, which showed higher relapse rates after 8 weeks of daclatasvir + sofosbuvir therapy in HIV/HCV‐coinfected subjects than the 12 week treatment arm . It is important to highlight, though, that all relapses in the ALLY‐2 trial only occurred in patients with higher baseline HCV viral loads.…”

Section: Discussionmentioning

confidence: 98%

“…Nevertheless, Neukam et al claimed recently that HIV coinfection is an independent risk factor for a reduced rate of SVR 12 weeks after treatment completion (SVR12) in HCV-coinfected individuals. Furthermore, they suggested that HIV-coinfected individuals are at higher risk of relapse [15].…”

Section: Introductionmentioning

confidence: 99%

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Rates of sustained virological response 12 weeks after the scheduled end of direct‐acting antiviral (DAA)‐based hepatitis C virus (HCV) therapy from the National German HCV registry: does HIV coinfection impair the response to DAA combination therapy?

Bischoff

Mauss

Cordes³

et al. 2018

HIV Medicine

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 98%

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Rates of sustained virological response 12 weeks after the scheduled end of direct‐acting antiviral (DAA)‐based hepatitis C virus (HCV) therapy from the National German HCV registry: does HIV coinfection impair the response to DAA combination therapy?

Bischoff

Mauss

Cordes³

et al. 2018

HIV Medicine

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“…While response to DAA treatment in HIV/HCV coinfected patients tended to be lower in the early DAA era, modern HCV DAA regimens yield SVR rates in HIV/HCV coinfected patients of >95%, and thus, HIV/HCV coinfected patients no longer represent a ‘difficult‐to‐cure’ patient population . We observed a response rate of 64.7% (22/34) to PEGIFN‐based treatment vs 87.5% (49/56) to DAA‐based regimens in our study cohort.…”

Section: Discussionmentioning

confidence: 63%

Epidemiological trends in HCV transmission and prevalence in the Viennese HIV+ population

Schmidbauer

Chromy

Schmidbauer

et al. 2020

Liver International

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Background & Aims Human immunodeficiency virus (HIV)/hepatitis C virus (HCV) coinfection is common in people who inject drugs (PWIDs). Recently, ‘high‐risk’ behaviour among men who have sex with men (MSM) has emerged as another main route of HCV transmission. We analysed temporal trends in HCV epidemiology in a cohort of Viennese HIV+ patients. Methods Hepatitis C virus parameters were recorded at HIV diagnosis (baseline [BL]) and last visit (follow‐up [FU]) for all HIV+ patients attending our HIV clinic between January 2014 and December 2016. Proportions of HIV+ patients with anti‐HCV(+) and HCV viraemia (HCV‐RNA(+)) at BL/FU were assessed and stratified by route of transmission. Results In all, 1806/1874 (96.4%) HIV+ patients were tested for HCV at BL. Anti‐HCV(+) was detected in 93.2% (276/296) of PWIDs and in 3.7% (31/839) of MSM. After a median FU of 6.9 years, 1644 (91.0%) patients underwent FU HCV‐testing: 167 (90.3%) of PWIDs and 49 (6.7%) of MSM showed anti‐HCV(+). Among 208 viraemic HCV‐RNA(+) patients at BL, 30 (14.4%) had spontaneously cleared HCV, 76 (36.5%) achieved treatment‐induced eradication and 89 (42.8%) remained HCV‐RNA(+) at last FU. Among 1433 initially HCV‐naive patients, 45 (3.5%) acquired de‐novo HCV infection (11.1% PWIDs/80.0% MSM; incidence rate (IR) 0.004%; 95% confidence interval [CI] 0.0%‐0.022%) and 14 had HCV reinfections (85.7% PWIDs/14.3% other; IR 0.001%; 95% CI 0.0%‐0.018%) during a median FU of 6.7 years (interquartile range 7.4). Conclusion Hepatitis C virus testing was successfully implemented in the Viennese HIV(+) patients. Anti‐HCV(+) prevalence remained stable in HIV+ PWIDs but almost doubled in HIV+ MSM. De‐novo HCV infection occurred mostly in MSM, while HCV reinfections were mainly observed in PWIDs. HCV treatment uptake was suboptimal with 42.8% remaining HCV‐RNA(+) at FU.

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“…[3][4][5][6][7][8][9][10] For HIV/HCV-coinfected patients, high rates of SVR have also been reported. [7][8][9][10][11][12][13] However, it is not known whether some benefits of SVR to PegIFN/RBV on nonhepatic outcomes might be extrapolated to DAA. On the contrary, some clinical events, such as HCC, herpes virus and hepatitis B virus reactivations, have been suggested to be related with the use of DAA combinations.…”

Section: Introductionmentioning

confidence: 99%

Early emergence of opportunistic infections after starting direct‐acting antiviral drugs in HIV/HCV‐coinfected patients

Macı́as

Téllez

Rivero‐Juárez

et al. 2018

Journal of Viral Hepatitis

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Varicella-zoster virus and hepatitis B virus reactivations have been reported after starting interferon-free direct-acting antiviral agent (DAA) combinations. HIV/HCV-coinfected patients could be a high-risk group for the reactivation of latent infections. Because of these, we report the occurrence of severe infections after starting DAA regimens in HIV/HCV-coinfected patients. Individuals included in the HEPAVIR-DAA (NCT02057003) cohort were selected if they had received all-oral DAA combinations. A retrospective review of clinical events registered between the start of DAAs and 12 months after SVR12 was carried out. Overall, 38 (4.5%) of 848 patients presented infections. The incidence (95% confidence interval) of infections was 4.6 (3.3-6.3) cases per 100 person-years. The median (Q1-Q3) time to the infection since baseline was 23 (7.3-33) weeks. Five (13%) of the patients with infections died; four of them had cirrhosis. The frequency of previous AIDS was 21 (54%) for patients with infections and 324 (40%) for those without infections (P = 0.084). The median (Q1-Q3) nadir CD4 cell count of individuals with and without infections was 75 (53-178) and 144 (67-255) cells/μL, respectively (P = 0.047). Immunodepression-associated infections were observed in 9 (1.1%) patients. All of them had suppressed HIV replication with antiretroviral therapy. In conclusion, severe infections are relatively common among HIV/HCV-coinfected patients receiving all-oral DAA combinations. Some unusual reactivations of latent infections in patients with suppressed HIV replication seem to be temporally linked with DAA use.

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HIV-coinfected patients respond worse to direct-acting antiviral-based therapy against chronic hepatitis C in real life than HCV-monoinfected individuals: a prospective cohort study

Abstract: HIV-coinfection is associated with worse response to DAA-based therapy against HCV infection. In patients receiving IFN-free therapy, this fact seems to be mainly driven by a higher rate of relapses among HIV-coinfected subjects.

Cited by 33 publications

References 25 publications

Rates of sustained virological response 12 weeks after the scheduled end of direct‐acting antiviral (DAA)‐based hepatitis C virus (HCV) therapy from the National German HCV registry: does HIV coinfection impair the response to DAA combination therapy?

Rates of sustained virological response 12 weeks after the scheduled end of direct‐acting antiviral (DAA)‐based hepatitis C virus (HCV) therapy from the National German HCV registry: does HIV coinfection impair the response to DAA combination therapy?

Epidemiological trends in HCV transmission and prevalence in the Viennese HIV+ population

Early emergence of opportunistic infections after starting direct‐acting antiviral drugs in HIV/HCV‐coinfected patients

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